1912133570 NPI number — DR. MATTHEW CHARLES WERTHAMMER MD

Table of content: DR. MATTHEW CHARLES WERTHAMMER MD (NPI 1912133570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912133570 NPI number — DR. MATTHEW CHARLES WERTHAMMER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WERTHAMMER
Provider First Name:
MATTHEW
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912133570
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4190
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARBOURSVILLE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25504-4190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-399-4405
Provider Business Mailing Address Fax Number:
304-399-2526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 1ST AVE
Provider Second Line Business Practice Location Address:
OPC SUITE 10
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-525-6825
Provider Business Practice Location Address Fax Number:
304-525-0300
Provider Enumeration Date:
06/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  23611 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 613918805 . This is a "BLACK LUNG/FEC" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 7100087680 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8103289 . This is a "CIGNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 9001376 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2990385 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810015863 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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